Breasts, Axillae & Regional Lymphatics (Exam 2)

Question 1

2 Types of Glandular Tissue

Answer 1

• lobules
• lactiferous sinuses

Question 2

Lobules

Answer 2

clusters of alveoli that produce milk that empties into a lactiferous duct

Question 3

Lactiferous sinuses

Answer 3

reservoirs for holding milk

Question 4

Suspensory (Cooper) Ligaments

Answer 4

fibrous tissue that support breast tissue, and attaches to chest wall

Question 5

Adipose Breast Tissue

Answer 5

bulk of breast tissue composition, varying proportions based on things like age, cycle, pregnancy, lactation, and nutrition

Question 6

What are the 4 quadrants of the breast?

Answer 6

Upper inner, upper outer, lower inner, and lower outer (plus tall of spence)

Question 7

Where is the location of most breast tumors?

Answer 7

upper outer quadrant

Question 8

4 Lymphatic Nodes of the Breast

Answer 8

central axillary nodes, pectoral, subscapular, and lateral

Question 9

The nipples in females have….

Answer 9

tiny milk duct openings

Question 10

Montgomery glands (areolas)

Answer 10

small rounded elevations formed by sebaceous glands that aid in lactation

Question 11

Epidermal ridges (milk lines) present during…

Answer 11

embryonic life

Question 12

Where does breast tissue develop?

Answer 12

develops along the ridge of the thorax, rest of the ridge atrophies

Question 13

Supernumerary nipple (third nipple)

Answer 13

may persist along the track of the ridge; usually inverted, flat, and non functional

Question 14

Puberty: _________ stimulate breast tissue changes

Answer 14

estrogen levels

Question 15

How does estrogen stimulate breast tissue changes in puberty?

Answer 15

enlargement of fat deposits, growth of duct system, and potential development of alveoli

Question 16

Aromatase

Answer 16

fat cells, that secrete a form of estrogen

Question 17

Higher BMI is linked to….

Answer 17

earlier onset of breast tissue development

Question 18

How has the mean onset of breast development been affected in the last century?

Answer 18

development has dropped, possible due to obesity epidemic

Question 19

Breast tissue changes vary by….

Answer 19

race, ethnicity and BMI

AA: 8.8 years
Hispanic: 9.2 years
White: 9.6 years
Asian: 9.9

Question 20

What is Tanner staging?

Answer 20

the five stages of breast tissue development

Question 21

What are the 5 Tanner stages?

Answer 21

I- Prepubertal
II- Breast budding
III- Enlargement
IV- Secondary mound formed by areola
V- Single contour of breast and areola

Question 22

Thelarche

Answer 22

beginning of breast development

Question 23

Full development of stages 2-5 of breast tissue development average over…

Answer 23

3 years; pubic and axillary hair develops as well

Question 24

Menarche

Answer 24

onset of menstruation; occurs in tanner stage 3-4 around 12 yrs old

Question 25

Size of fully developed females may ebb and flow with….

Answer 25

hormonal changes during cycles

Question 26

Pregnancy: breast changes occur during which month?

Answer 26

second month; early sign of pregnancy

Question 27

Why do breasts enlarge and feel more nodular during pregnancy?

Answer 27

expansion of ductal systems, supporting fatty tissue, development of true secondary alveoli

Question 28

What happens to areolae during pregnancy?

Answer 28

they become larger and darker as pregnancy progresses, color may fade after but size remains; increased vascularity as well

Question 29

When is colostrum expressed during pregnancy?

Answer 29

Fourth month

Question 30

What is colostrum?

Answer 30

precursors for milk, containing protein and lactose; produced again after the first few days of delivery that are rich in antibodies

Question 31

What decreases/atrophies during post-menopause?

Answer 31

ovarian secretion of estrogen and progesterone, breast glandular tissue (replaced with fibrous connective tissue), subcutaneous tissue, axillary hair

Question 32

Breast cancer specific mutations

Answer 32

BRCA 1 and BRCA 2

Question 33

A woman today is _____ as likely to die of breast cancer than 30 years ago

Answer 33

half

Question 34

Mammography ages

Answer 34

annual screening for at risk women 40-44 years of age, and definite for 45

Question 35

Mammography barriers

Answer 35

lower income, lower education levels, unemployment, pain, embarrassment, and lack of health insurance

Question 36

Modifiable Breast Cancer Risk Factors (7)

Answer 36

• nulliparity or first child after 30 years old • current oral contraceptive use • long term use of HRT • not breast feeding • excessive alcohol intake • obesity (especially after menopause) • physical inactivity

Question 37

Non-modifiable Breast Cancer Risk Factors (9)

Answer 37

• first degree relatives of BC patients who were diagnosed premenopausal and had bilateral disease HAVE GREATEST RISK • female over 50 years old • personal history • BRCA 1 or BRCA 2 gene mutation • history of hyperplasia on biopsy • previous breast irradiation • menarche before 12 yrs old • menopause after 50 years old • white people

Question 38

Breast: Collecting Subjective Data (9)

Answer 38

• pain • lumps • discharge (color, consistency, odor) • rash • swelling • trauma • history of breast disease • surgery/radiation • medications

Question 39

Breast PCC: Subjective Data (2)

Answer 39

• breast self examination • last mammogram

Question 40

Axilla: Subjective Data (2)

Answer 40

• tenderness, lump or swelling (lymph nodes) • rashes (allergic reaction?)

Question 41

Breast: Collecting Objective Data (4)

Answer 41

• note appearance of skin • size and symmetry (slight asymmetry is normal) • contour • characteristics of nipple

Question 42

Positioning for retraction screening for breasts

Answer 42

arms at sides and over head, hands against hips, leaning forward

Question 43

Retraction could be a sign of….

Answer 43

fibrosis (dimpling or puckering)

Question 44

Inspecting/Palpating Axillae

Answer 44

• note rashes/ discoloration • note enlarged and tender lymph nodes • lymph nodes not usually palpable • some tenderness is EXPECTED high in axilla

Question 45

How to palpate axillae? (4)

Answer 45

I- down the chest wall from the middle of the axilla II- anterior border of axilla III- posterior border of axilla IV- inner aspect of inner arm

Question 46

What position is most beneficial for palpating lumps?

Answer 46

supine; pillow under shoulder

Question 47

How to palpate breast?

Answer 47

use pads of first 3 fingers to make gentle rotary motion, varying pressures; vertical strip pattern for detecting lumps (start high in axilla and palpate down midaxillary line)

Question 48

Palpating nipples

Answer 48

observe any masses or discharge

Question 49

What to note when lumps/masses are detected (10)

Answer 49

• location • size • shape • consistency • movable • distinctness • nipple • skin over the felt lump • tenderness • lymphadenopathy

Question 50

BREAST acronym

Answer 50

B- Breast mass R- Retraction E- Edema A- Axillary mass S- Scaly nipple T- Tender breast

Question 51

Best time of the month for breast self examinations (BSE)?

Answer 51

day 4-7 of cycle (after menstrual period)

Question 52

Benign (Fibrocystic) Breast Disease Characteristics (8)

Answer 52

• multiple tender masses • swelling and discomfort • nodularity • mastalgia • cysts • infection and inflammation • DOMINANT LUMPS • NIPPLE DISCHARGE

Question 53

Benign Breast Disease Breast Lumps (9)

Answer 53

• round or lobular • firm/soft/rubbery • well demarcated • usually more than one • mobile • NO skin retractions • tender and possible changes with menses • size changes • decrease incidence after 50 years old with menopause

Question 54

Malignant Breast Lumps (8)

Answer 54

• 30-80 years old and increases after 50 yrs • irregular or star shaped • firm to stone hard • poorly defined • single • usually non tender • skin retraction- dimpling • continues to grow

Question 55

Preventing Lymphedema in a Mastectomy Patient (3)

Answer 55

• no blood pressure or needle sticks in affected limb • patient usually wears compression sleeve • limb alert bracelet

Question 56

Assessing the Male Breast

Answer 56

can be abbreviated but NOT omitted; inspect chest wall, palpate nipple area and axillary lymph nodes

Question 57

Gynecomastia

Answer 57

benign growth of male breast tissue; unilateral or bilateral and usually benign

Question 58

Gynecomastia could be related to…

Answer 58

anabolic steroids, medications and liver disorders

Question 59

Male breast cancer

Answer 59

is rare; usually painless, firm, retro-areolar lump

Question 60

When does the engorged breast during lactation occur?

Answer 60

postpartum day 3 or 4

Question 61

4 common abnormal breast findings

Answer 61

• dimpling • nipple retraction • edema (peau d’orange) • deviation in nipple pointing

Question 62

3 Nursing Diagnosis for Breasts

Answer 62

• disturbed body image • ineffective coping • grieving

Question 63

SUMMARY CHECKLIST: BREASTS AND REGIONAL LYMPHATICS EXAM (5)

Answer 63

I- inspect breasts as patient sits, raises arms overhead, pushes hands on hips, leans forward II- inspect supraclavicular and infraclavicular areas III- palpate axillae and regional lymph nodes IV- with patient supine, palpate breast tissue including tail of spence, nipples and areolae V- teach BSE (?)